Zahoor Mahrukh, Abbass Safdar, Khan Asif Ali, Ahmad S Afzal
Department of Cardiac Surgery, Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi, Pakistan.
J Ayub Med Coll Abbottabad. 2007 Oct-Dec;19(4):49-54.
During cardiac surgery, cardiopulmonary bypass (CPB) leads to haemodilutional anaemia and activation of inflammatory mediators, affecting haemostasis. Modified Ultrafiltration (MUF) is being increasingly favoured for haemoconcentration without blood transfusion and reducing post operative bleeding.
Aim of this study was to record the impact of modified ultrafiltration on haemoconcentration and postoperative bleeding during adult cardiac surgery. This randomized control trial included 100 patients, divided into 2 groups; MUF and control group. Serial blood samples were drawn to evaluate haematological indices. Postoperative chest drainage was recorded for 24 hours. Results were expressed in terms of percentages, means and p value (p < 0.05 was taken as significant).
Four patients were excluded and 96 patients were analyzed (MUF n = 50, control n = 46). According to American society of anaesthetist (ASA) classification, MUF group was higher risk group (p = 0.02) with longer extracorporeal perfusion time (p < 0.001). Haemoconcentration was successfully achieved in MUF group (final haemoglobin = 10.7 +/- 1.25, haematocrit = 33 +/- 3.64%, p < 0.001) with lower blood loss (MUF = 395 +/- 153 ml, control = 755 +/- 435 ml, p < 0.001) and transfusion requirement (p < 0.001). Re-exploration rate was 4% and 6.5% in MUF and control group respectively (p = 0.57). Mortality in both groups was comparable (MUF = 4%, control = 4.3%, p = 0.94).
Modified ultrafiltration is a safe procedure which successfully achieves haemoconcentration, lowers blood loss and transfusion requirement after cardiac surgery in adult population.
在心脏手术期间，体外循环（CPB）会导致血液稀释性贫血和炎症介质激活，影响止血功能。改良超滤（MUF）越来越多地被用于血液浓缩，避免输血，并减少术后出血。
本研究的目的是记录改良超滤对成人心脏手术期间血液浓缩和术后出血的影响。这项随机对照试验纳入了100例患者，分为两组；MUF组和对照组。采集系列血样以评估血液学指标。记录术后24小时的胸腔引流量。结果以百分比、均值和p值表示（p < 0.05为有统计学意义）。
4例患者被排除，96例患者纳入分析（MUF组n = 50，对照组n = 46）。根据美国麻醉医师协会（ASA）分级，MUF组为高风险组（p = 0.02），体外循环灌注时间更长（p < 0.001）。MUF组成功实现了血液浓缩（最终血红蛋白 = 10.7 +/- 1.25，血细胞比容 = 33 +/- 3.64%，p < 0.001），失血量更少（MUF组 = 395 +/- 153 ml，对照组 = 755 +/- 435 ml，p < 0.001），输血需求更低（p < 0.001）。MUF组和对照组的再次手术率分别为4%和6.5%（p = 0.57）。两组的死亡率相当（MUF组 = 4%，对照组 = 4.3%，p = 0.94）。
改良超滤是一种安全的操作，能在成人心脏手术后成功实现血液浓缩，减少失血量和输血需求。
